How is tubal ligation reversed at our center?

Our practice was among the early pioneers of outpatient tubal reversal surgery.

In the 1970’s female sterilization reversal was performed in hospitals, surgery times exceeded three (3) hours, self-retaining retractors were routinely used, and patients were hospitalized for several days. This made tubal reversal surgery a major production and unaffordable for many.

Mini-incision Tubal Ligation Reversal

We began performing tubal reversal surgery in an outpatient ambulatory setting in 1996. We perfected our techniques and streamlined our approach such that most reversal surgeries are sixty (60) to ninety (90) minutes. We made smaller incisions and minimized the use of self-retaining retractors. Our patients now enjoy the benefits of shorter operating times and quicker recoveries with much less pain than the more traditional approach to tubal reversal surgery.

We have been able to keep the tubal reversal surgery affordable and successful.

Type of Tubal Ligations Reversed

We are able to reverse over 98% of the tubal ligations among all the patients who have surgery at our center. These women all have a chance at natural conception and pregnancy.

Tubal clips: Filshie and Hulka clips

A common method of tubal ligation is Filshie or Hulka clip tubal occlusion. Tubal clip ligations are often performed six (6) weeks or more after pregnancy and delivery. These procedures or often performed laparoscopically (small camera inserted through the belly button). Occasionally tubal clips can also be applied directly to the tubes during a c-section.

Filshie clip on fallopian tube causing complete separation and closure of the tube.

Tubal clips cause blockage of the tube by exerting pressure on a small section of the tube. This causes the blood supply to that area to decrease and the tissue undergoes changes which result in the tube healing closed and separating. The tubal clips serve no function after the tubal ends have closed and separated.

Tubal clips are an excellent tubal ligation method for reversal and reversal of clips often provides the highest chance of pregnancy success. Why?

Compared to other tubal ligation methods, fallopian tube clips only damage a very small portion of the fallopian tube when they cause tubal blockage. It is technically easier to rejoin the tubal segments because the sections of fallopian tube are more similar in size.

When we repair a clip tubal ligation we are often more certain the remaining fallopian tubes will be healthy and long. In comparison to other tubal ligation methods, the performance of clip tubal ligation is more similar among doctors than ligation and resection (cutting and tying) or coagulation (burning). This means the technique is fairly consistent among doctors and the reversal results are more predictable.

Many mistakenly believe reversing clips is as simple as just removing the clip and the tube will be reopen. Unfortunately it is not quite that easy. The clips have to be removed, the closed ends opened, and the tubal ends rejoined using microsurgical techniques.

Pregnancy success after reversal of tubal clips can be as high as 80%.

Tubal rings: Falope, Yoon, Silastic bands

Tubal ring tubal ligation is also a common method of tubal ligation which causes minimal damage to the fallopian tubes. Tubal clips are often applied during a laparoscopic (small camera inserted in the belly button) procedure.

Similar to tubal clips, tubal rings are an excellent method for tubal reversal.

Tubal rings cause blockage of the fallopian tube in a manner similar to tubal clips. Tubal rings do damage slightly more of the fallopian tube than tubal clips but this does not seem to adversely impact pregnancy success rates after reversal.

As with tubal clips, reversal of tubal rings cannot simply be performed by removing the rings. The rings cause the tubal ends to heal closed and the ends will separate. To reverse the effects of tubal rings, the rings must be removed, the tubal ends reopened, and the fallopian tube ends rejoined with microsurgical techniques.

Pregnancy success after reversal of tubal rings can be as high as 80%.

Cutting and tying: Pomeroy, Parkland, Irving, and Uchida

When tubes are cut and tied during a tubal ligation the more correct term for this method is ligation (tying) and resection (to remove by cutting). This is a very common method of tubal ligation when performed during a c-section or within the first 24 hours after a vaginal delivery.

Although most people are aware of the concept of cutting and tying tubes very few people actually understand the exact reasons for each step. A small segment of the tube is tied first before it is cut. The purpose of the suture is to prevent bleeding. The tube will then be cut to cause physical disruption of the fallopian tube. The suture will eventually be absorbed and the closed ends of the tubes will separate.

Ligation and resection methods are reversible and with good success but this method is more dependent on the different techniques of individual doctors. Some doctors remove minimal amounts of tube and others may remove larger amounts, the ends of the tubes, and, in rare cases, both tubes in their entirety.

It is helpful for us to review the operative and pathology reports of these types of tubal ligation so we can determine both the technique and the amount of tube removed by a patient’s doctor.

Pregnancy success after reversal of ligation and resection averages 66%.

Burning: Bipolar and monopolar coagulation

Tubal coagulation is also known as tubal burning. Although this method sounds like an extreme way to cause tubal blockage it is very common, despite popular opinion, is also very reversible if the doctor did not burn too much of the tube.

Tubal coagulation exists in two forms: bipolar and monopolar coagulation. Bipolar is the most common type and is the least destructive of the two.

Tubal coagulation is often performed during a laparoscopic procedure (camera inserted through the belly button). It is very typical for a doctor to perform a one (1) to two (2) cm burn or to burn the tube in 3 (three) adjacent spots.

Burned tubes can often be successfully repaired but this method is dependent on the technique of individual doctors. Some doctors will coagulate small amounts and other will coagulate larger amounts. Some will coagulate the tube close together

Pregnancy success after reversal of tubal coagulation averages 66%.

Hysteroscopic tubal occlusion: Essure sterilization

Dissecting the proximal portion of the Essure device as it travels through the muscle of the uterus.

Essure is a newer sterilization procedure which causes occlusion (blockage) of each fallopian tube from the inside.

During the Essure procedure a micro-insert device composed of two coils is inserted into the very opening of each fallopian tube from inside the cavity of the uterus. The micro-insert device causes scar tissue to form inside the fallopian tube and this causes permanent blockage of each tube.

We were the first physicians in the world to publish case reports on successful pregnancy after outpatient Essure reversal. Essure can be reversed by surgically removing the coils and then re-inserting the remaining healthy fallopian tube into the cavity of the uterus.

The chance of pregnancy after reversal of Essure sterilization is approximately 35%.

Can your tubal ligation be reversed?

In my experience we have found that most types of tubal ligation can be reversed and provide patients with a chance of natural pregnancy. Tubal reversal can be more affordable and successful than in-vitro fertilization, every month provides a chance at pregnancy, and provides patients with the opportunity to become pregnant more than once.

What Our Patients Are Saying

"Dr. Monteith prepared me mentally for the pre, during and post procedure journey. He also provided me with all the tools necessary for a comfortable recovery. I'm definitely confident in this Dr's work, and especially glad at how little pain I experienced throughout the process. It would be worth it to visit Dr. Monteith no matter what state you have to travel from, I drove from Virginia."

- J.R.

"Very comforting and knowledgeable experience not only was the staff pleasant so was the atmosphere! I drove 3 hours so i did my research. I was impressed with the information, visuals, and on hand knowledge about what the procedure was all about. I felt like an expert after i left! Not to mention the 45 min in and out time. I will be recommending this to all my colleagues thank you!"

- J.W.

"Dr Monteith, and his staff, were all very professional about my decision to have a vastectomy. They informed me of the risks, the surgery procedure, and the post-surgery care. The procedure itself was relatively painless. I would rate this as a 2/10. I highly recommend Dr Monteith; he even sent me a text message after the surgery to give me a personal update on my procedure. The procedure was quick."

- S.E.

"If you're in the market for a Vasectomy you need to give Dr. Monteith a serious look. Just compare the information on his website to the information you'll get from other options around the triangle. It's hard to get solid answers on cost, procedure and expectations up front from other offices but A Personal Choice plays no games and has great informative well designed website. Dr. Monteith makes it easy!"

- J.P.

"Excellent care. I visited Dr. Monteith for a single visit appointment on a Friday. Very clean, comfortable office. Pleasant staff. The procedure was quick and I went back to work for a little while. The only pain I experienced was soreness beginning about 4 hours post procedure, lasting for 24 hours, then subsiding rapidly. I was fine by Monday. The office checked on me twice, no problems. I would recommend Dr. Monteith to anyone.

- M.D.

Ask Us A Question!

Your questions about our services will be answered directly and promptly by our staff or Dr. Monteith. We will not respond to general medical questions or if you are a patient of another practice and are contacting us because you are not getting answers from your physician.

If you have been a patient at our center and have specific questions about your medical care you should contact the staff directly at (919) 977-5050.